Missed Call By Mayleen Laico, M.D.
Chong Hua Hospital
Cebu City, Philippines
One
It was early in the morning on the fifteenth of December, when BTS’s “Yet to Come” marked the start of Mary Abram’s day. Being almost midway through the last year of residency training in internal medicine, she is used to waking up before daylight. Grabbing the phone from the nightstand, she shuts off the alarm, lays back down and with eyes closed contemplates the day ahead. Her husband Jerry, who is a nephrologist, stirs slightly but immediately goes back to a comfortable sleep.
Today will be a busy day as always, with morning report to begin the day, then rounds with her team on the patients on their service and finally in the afternoon is her outpatient continuity clinic. Jonah her three-year old will spend his day in daycare as has been the case since a year ago. With much anticipation, she remembers that her parents are coming back from their vacation from the Philippines this afternoon.
It is now 6 am and time to wake up Jerry who too will have a long day ahead being a part of a busy nephrology group. She turns to him saying “Wake up honey, you have to help get Jonah ready”. Jerry opens his eyes slightly and after stretching his arms, gets out of bed and heads for the bathroom.
Mary heads to the kitchen to prepare breakfast.
Two
Traffic was heavy as usual, but Mary still made it to the hospital with much time to spare before morning report at 730 am. Morning report always interests her with the many and diverse cases presented by the first-year residents. The list of admissions was quite long with most cases being Community Acquired Pneumonia, it being the winter season. There were a few new admissions to Mary’s service. Being the third-year resident, she had second- and first-year residents in her team. After morning report, they head off to the seventh floor where the internal medicine patients were admitted. Gathering their stack of charts, they began with Mr. Joe Humphrey who was admitted the night before for Acute Cholecystitis.
As they headed to his room, Mary, made a mental note to visit her younger sister, Jessica Lee, who was in the peritoneal dialysis clinic for her monthly check-up. Her sister who is twenty-one years old was diagnosed to have end stage renal disease since she was 18 years old. Being that she is a nutrition student the family decided on peritoneal dialysis as renal replacement therapy while waiting for a suitable organ donor. After seeing her remaining patients, Mary saw that it was almost 11 am and therefore, time to make a quick stop at the PD clinic.
As she entered the clinic, she saw her sister having a conversation with the unit coordinator. Apparently, her monthly laboratories were all excellent, having been compliant to her dialysis and medications. It was not always easy for Jessica but after three years on dialysis she has finally adjusted to the treatments and lifestyle change.
As she went into the unit, Mary’s cellphone rang. The caller ID showed an unknown number. Dismissing the call, she stayed with Jessica until the consultation finished and decided to join her husband Jerry for lunch at the hospital cafe. As she sat down with her tray a “Code Blue Emergency Room “was called overhead. Not being a part of the Code Blue Team, she continued her lunch with Jerry. “So how was your morning?” Jerry asked. “The usual. I visited Jess at the PD clinic.” Mary answered. “I am glad she is doing very well. Hopefully she will find a match soon” Jerry said. Since Mary was finished with lunch, with a final gulp of orange juice she said goodbye to Jerry and headed to the Outpatient Clinics.
Three
Jessica was leaving the PD clinic when her cellphone rang. It was the Organ Transplant Coordinator informing her that they have a possible match for her. She was to stay on standby. She immediately called her parents, who should have arrived in the US by now from their overseas trip, but her call went to voicemail. She called Mary, but she could not be reached either. Jessica decided to head back to her apartment to await news from the transplant center.
In the meantime, Jerry started with his rounds. He went first to the dialysis unit to check on his patients then proceeded to the ICU to see the patients referred to the nephrology group. When he entered the unit, there were a large group of people in one of the rooms. He asked the head nurse “What is going on there?” The head nurse answered “It is trauma patient. A vehicular accident on the freeway from the airport. The husband is in surgery. That is the wife. Brain death has occurred, and she has an organ donor card. The husband has given consent for organ harvest. They have been trying to reach the children, but their calls were not answered.”
Jerry continued to see the rest of his patients and headed for his nephrology clinic in another part of the building.
Four
Mary was finishing with her last patient in the outpatient clinic when she noticed her silent phone. She took the phone out of her pocket, only to discover that her phone was completely dead. She did not have her battery pack with her, so she decided to finish quickly and head for her locker where the charger was, besides it was almost time to go home and time to pick up Jonah from daycare. As she plugged her phone and turned it on, she saw several missed calls, from her sister Jessica and some unknown numbers. Deciding to call back Jessica first, her call went to voicemail. She left a message asking Jessica to call her back. As she was leaving, she saw the nephrology fellows excitedly talking about the potential transplant donor who was matched to one of their dialysis patients. She decided to call Jerry to find out if he also received calls from Jess. Unfortunately, Jerry’s phone was also unavailable.
Five
Mary arrives home with Jonah, as the sun is setting. Twilight is a wonderful time for her to spend a couple of minutes with her baby away from the hustle and bustle of the hospital. Jerry will be late tonight because of the scheduled monthly nephrology group dinner. She remembers that her parents were supposed to have arrived at their home only a couple of blocks away, but there have been no calls from them. Wondering if their flight was delayed, she looks up the flight status online and sees that the flight has landed as schedule before noon. Starting to worry, she tries to call Jess only to be sent to voicemail once again. Thinking that her parents must have been exhausted and jet-lagged from their trip, she put Jonah to bed and decided to sleep early. After all her team would be on call tomorrow and she will be the senior resident at the ICU tomorrow.
Six
Mary woke up with a start as her iPhone blares out BTS’s “Yet to Come”. Remembering that she is assigned to the ICU today, she immediately stood up. ICU endorsements are long and complicated. The earlier the day starts the better for everyone especially for the post call ICU residents. Jerry stirs as she stands up, tells her that he too will be covering for the nephrology service in the ICU today. The original nephrologist was out with the flu. Looking forward to the long day ahead, they both got ready for work. It was Mary’s turn to drop Jonah off at the daycare.
Seven
As Jerry, arrives at the ICU still very early in the day, he asked the nephrology fellows regarding the new admissions and referrals. The fellows led him to a patient who received a kidney from a deceased organ donor the previous day. The patient was a nutrition student who was on peritoneal dialysis. The donor died from a vehicular accident from the airport. As Jerry approached the bed, he immediately recognized Jessica who was comfortable sleeping amidst monitors and IV fluids. At the same moment, Mary’s team of ICU residents, who have started with endorsements, overheard the story of the transplant patient. As they arrived at Jessica’s bed she recognized her sister, and immediately remembered not having heard from her parents since their arrival the day before. She immediately called her father, and as the call connected, she could hear a cellphone ringing from the next ICU bed. As she approached the bed, she saw it was her father. She asked where her mother was and he answered, “She lives in Jessica.
